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Hip Arthroscopy Post Arthroscopy recovery timescales

Worriermum

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Hi,
New to posting on online forums and I am posting to see if I can find out some info for my daughter, who is 21 and has both FAI (Cam) and mild dysplasia (acetabular retroversion) with bilateral anteriorly-based labral tears. Having had moderate, occasional hip pain for about four years, a year ago the pain became constant, hurting when she was sitting, standing and walking. It eventually meant that taking stairs was painful and would result in falls. Her activities were severely restricted. We have been told that a misdiagnosis of Bursitis, and the exercises she was given to do to cure that condition likely increased the damage to her cartilage.

Unfortunately, no pain killers of any sort seem to help her. NSAIDs do not impact the pain and codeine based medicines make her extremely sick.

It took a long time to get a proper diagnosis. Following failed attempts at treating the problem with PT and then injections into the hips, it was decided that only surgery was going to help. She was told the first move would be arthroscopy but there was a chance that acetabular osteotomies might be required. Exactly two weeks ago today (on Wednesday 14.10.20) she had an arthroscopy. The specialist said the cartilage was far more shredded than expected and that it was no wonder she was in such pain. As we understand it, he trimmed it up and he reshaped the bone to correct the impingement (please forgive lack of medical wording). He told her they would not know whether it had been a success until the pain from the surgery had stopped. She has a follow-up consultation in two weeks.

She was sent home with instructions to get on an exercise bike with no resistance for half an hour several times a week to get the hip moving. However, since then she has had a really rough time of it, with her temperature shooting up on day 5 and feeling really ill. This has sorted itself out but now, but she has been fairly static for the past week and only been on the exercise bike - as directed - a couple of times.

The reason I am writing is because she is a bit stressed because she is in a lot of pain. The post-op pain has ebbed in the last couple of days, and now it has eased it has been replaced with pain within the joint which she says is the same as before the operation, but as bad as it was on her worst days.

She fears, understandably, that this may mean the operation has not been a success. I have tried to reassure her that it is VERY early days, but obviously I have no real knowledge on the subject and would be very grateful for any insight into what is normal from the point of view of post surgical pain trajectory. Thank you.
 

Jaycey

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@Worriermum Welcome to BoneSmart! Which hip had the procedure? I'll put the information in your signature for you.

Recovery from arthroscopy is not easy. And yes, it can be more painful than recovery from THR.

I am not sure why the surgeon suggested your daughter get on an exercise bike so early out. She is not in training for anything. She needs to let that hip heal from all the trauma. Walking is all a hip really needs.

Is your daughter icing and elevating that op leg? You will find instructions on how to do this in the information below.

And it does sound like her pain is not properly managed. What medication was she given?

Recovery from this procedure is going to take weeks, not days. In fact, it could take up to one year depending on how long she limped around pre-op. In the information below you will find some general guidelines on timeframes. These refer to THR recovery but the information also applies to arthroscopy.

Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of this BoneSmart philosophy for sensible post op therapy
5. Here is a week-by-week guide for Activity progression for THRs
6. Access these pages on the website

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
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Worriermum

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Hi, thank you so much for your reply
It was her RIGHT hip

She was given Diclofenac and Codeine (possibly Dihydrocodeine?), and, because she has so many issues relating to sickness etc, they gave her anti-emetics and Omeprazole. But unfortunately when she became ill last week, she was throwing up so much that she didn't keep any food down for about four days. So she was told by the GP to come off everything.

Throughout the whole of the past year, it proved that none of the pain meds (Naproxen, Celebrex, Co-Codemol, Codeine in various forms) she was prescribed worked or they made her sick. The GP also tried her on Amitriptyline and she became totally unaware of her surroundings, terrified and ended up phoning me to say she was wandering and lost in her university city, so decided that was definitely not the route for her. After that she was told there was nothing else she could be given. She will now only take the Codeine if she is absolutely unable to bear the pain.

She hasn't really found icing it helps but I will certainly remind her about doing that.

She wasn't doing much limping before the op because both hips were equally bad. Silver lining?

She is actually at University at the moment. They have kindly arranged for her to have a ground floor room and she has a shower, so actually is better off there than here, where it is stairs everywhere. But it does mean my help is given remotely!
 

Jaycey

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She hasn't really found icing it helps but I will certainly remind her about doing that.
She probably isn't icing for long enough. Physios tell you to ice for 20 minutes. That is for people in training. She should ice for 45-60 minutes several sessions per day. This is even more important since she is not tolerating her medication.

Can she take paracetamol? It might take the edge off if she can tolerate it.
 
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Worriermum

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Great, I will tell her that. Thanks so much

She does take paracetamol at the moment, because she still isn't really better from whatever was wrong last week and has a constant headache (Covid test was negative by the way) but she isn't finding it is having any benefit for her hip.
 
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Worriermum

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Just need to come back with a follow up, if that's OK.
(The thread is a bit of a long read, so just to clarify: this thread refers not to me - the 50yr old mum - but my 21yr old daughter who had her arthroscopy on 14.10.20 - cam impingement, bilateral labral tears, mild dysplasia. This first operation was Right Hip, two incisions, some remodelling of femural head, trimming of shredded cartilage.
Has been told to use crutches for 4 weeks, and do physiotherapy on exercise bike.
Daughter cannot tolerate Codeine, no other pain meds touch it.
She is at university, doesn't live with me at the moment, so trying to provide support long-distance)

My daughter is pushing herself, as usual, and wont stop doing the exercise bike, as instructed by the physiotherapist. It is no-resistance and it is every other day for half an hour.
Apparently she asked the Physio at the time if the pain got really bad, should she stop, and was told that this particular exercise couldn't do any damage to the joint and so she should just carry on. It seems counterintuitive to me.

I have read on several sites online that the reason you are encouraged to do this exercise is to stop scar tissue forming within the joint. (I saw it in a thread on here somewhere too - I've lost it now, but someone else who had arthroscopy was advised this by their surgeon.)

My daughter was unable to do any exercise for probably a week post-op, apart from very minimal walking with crutches. Could this be what has happened? That scar tissue has formed? Although it appears to fly in the face of what you say above about hips healing themselves.

Her pain is still bad and is constant. She is icing the hip and lying down. She has started taking the Diclofenac again yesterday in the hope that the pain is inflammation and that this will help (although NSAIDs have never helped her before). As I mentioned above, she has no luck at all with any pain relief.

So worried about her pain levels, about the fact she is barely sleeping - but also about how desperately unhappy she is that now she has worse pain than she ever had before the operation - and whether this is her new normal. I am sure it isn't and please forgive me for venting on here!
 

Jaycey

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The decision is your daughter's - but forcing exercise is totally counterproductive and she is seeing the results. PT should not be pushing this at all! Rest, ice and elevate. Your daughter is not in training! Frankly the pain is not going to decrease if she keeps up this totally unnecessary biking. And BTW - scar tissue is not at all an issue.

Hope the diclofenac works for her. It's not something she should take long term. But I found it quite effective in reducing inflammation.
 
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Worriermum

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Things are still not going very well. About a week ago, my daughter had to do some university work which required her to walk 20mins each way to get there and then spend nearly 3 hrs on her feet. It was a practical test and couldn't be done any other way - and she had already missed one when she was feverish post-op. I don't know if this was a trigger, because the worsening wasn't immediately afterwards - it was two days later she woke to find she was in far more pain and this has now continued with no improvement at all for over a week.

Confusingly, in the meantime the blood test results from when she was feverish after the operation reached her doctor, who phoned and said the raised CRP levels showed she had had an infection. This is the opposite to what the specialist said: he thought they were perfectly normal levels of inflammation for someone who had had an operation only a week earlier, and that she had most likely had an unrelated virus. (In retrospect, I wonder if all her post operative feverishness etc was caused by a reaction to the codeine, as she has always reacted to it even in small doses - everything she had wrong with her is on the list of side effects and she was taking a LOT after the op. Plus she got better quite quickly once the doctor told her to stop taking it.)

On Monday this week (Nov 9) she went to see the specialist for her 4 week post op follow-up. He was clearly surprised her pain wasn't better now than before the operation (I should say he is very experienced in this particular hip problem in young people, it is his main focus). He was very nice. She was told he would speak to her doctor about pain relief and that he would see her again in four weeks. He said, "Well, it was a LOT of remodelling".

She specifically asked about whether she should stop using the static exercise bike (no resistance, just movement) and he said to continue.

I probably shouldn't have started looking at other threads, but having done so, I am starting to fear some sort of infection and wonder if you could reassure me. Things are so hard right now. With NHS doctors rushed off their feet with Covid-related problems, you do tend to get brushed off about anything else. And pain is impossible to see and quantify.

(I realise that it must be very irritating that she won't follow your advice and stop the exercise bike - I think it is understandable that she doesn't want to go against the specialist's recovery schedule, although he wants her to do it every day and she is doing every other day instead; that is just the sort of person she is, please don't be too harsh when replying !! - but she has been resting it and icing it.)
 
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Layla

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Hello @Worriermum

Two twenty minute walks and three hours on your feet is rather ambitious at only three weeks post surgery. It’s no wonder your daughter is dealing with pain.

I’m sorry your daughter continues to struggle and I’m sure as a mom it’s heartbreaking to watch as you want her to be pain free and perfectly healed. I also understand that she doesn’t want to go against the advice of her specialist. I felt the same when I was new here. Reading countless stories of those who suffered set-backs due to over activity, either recommended or by personal choice made me a believer. What does your daughter have to lose if she abstains for 2-3 weeks, aside from the pain? She’ll never know unless she’s willing to give it a try.

As far as questioning the possibility of infection, I’d press for another test for peace of mind.

A low grade fever (less than 101.5 F) during the first week after surgery is a normal response by the body to the stress of surgery. It is most often caused by inflammatory response to the tissue injury sustained during surgery. After the first week if you have a fever that lingers for more than a few days, or if a fever over 101.5F begins several days after surgery, it's recommended that you contact your physician to rule out the possibility of anything serious.

I hope your daughter will be willing to try something different because what she’s doing doesn’t seem to be working in her favor. Please keep us posted, we’re here to offer support, advice and consolation if you need to vent.

Hugs and best wishes for healing and brighter days. :console2:
 
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Worriermum

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Thank you so much Layla, I really appreciate you taking the time to respond and being so sympathetic. And yes, I did kind of need to vent! Being far away from her and not being able to do anything practical or even give her a hug is pretty bad.

I agree with what you say about trying some time without PT and I think I will try, when she is feeling a bit less fragile (particularly bad day today) to push her to do that.

I guess it is just normal to assume that they have good reasons for pressing you into doing these exercises - and it doesn't help that she was told by the Physio on the day after her operation that, whilst it was normal in physiotherapy to advise people stop once it is causing pain, because she could "do no harm to it with these exercises", so she should just keep on whatever. As a result, this meant that on day 2 after the op, she forced herself to do 17mins on the exercise bike at the university gym and had to stop at that point because she was crying so much.

I just hope the doctor gives her some more sensible advice, some pain meds that actually work, well - any help really.

You are very kind. Thank you again.
 

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@Worriermum
Sorry to hear you daughter is in so much pain from her surgery a month ago.
Seems the surgeon and PT are treating this as an athletic injury recovery, when she has had major surgery on her right hip, and needs a gentler approach to her recovery.

I hope that the surgeon will give her some sensible advice to slow down and let those tissues heal.
 

Layla

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You’re welcome. Please know we’re here for you anytime.
I also hope your daughter receives good advice from her doctor along with an adjustment to her meds so she is comfortable. I’m sorry you have to worry from afar, unable to see or spend time with her. Hopefully things will begin to fall into place alleviating her pain and your worries. Prayers for her healing and your peace of mind.:prayer:
@Worriermum
 

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Worriermum

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Hello, lovely people. I have another question if that is OK.
The doctor has prescribed Amitrypteline for the pain. She did not tolerate this well before (became panicky and disorientated) but is starting at a lower dose and will build up, in the hope that she will deal with it better this time.
My question is this - that is a pain blocker, the aim being to stop the pain messages reaching her brain. But it doesn't cure the actual problem therefore. So does the inflammation resolve itself eventually? and how do you know if it has resolved if the drug is obscuring the pain? (ie: when do you know to stop taking it?)
 

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Hello @Worriermum
I am not a medical professional, but from what I’ve read, Amitrypteline, is prescribed for depression, or treating mental / mood problems, relieving anxiety and tension. It can be prescribed for eating disorders and post hermetic neuralgia, the burning stabbing aches or pains that may last after Shingles. Also used to prevent migraines.

The inflammation may resolve itself if she stops the overactivity, which it seems you’re not confident she will do. Your daughter needs to find a healthy balance between activity and rest as her body heals from the trauma of surgery. I fear if she’s not willing to do that she’ll continue to suffer pain. Hopefully she’s icing and elevating while resting at home.

Would your daughter be willing to talk to her Primary Care Physician about her prescriptions, posing the questions you raised above? Or, seek a second opinion from another Orthopedic surgeon if things don’t begin improving? I understand your concern as her mom. None of us want to see our kids suffer pain. It’s especially difficult for you as her mom because she is an adult and you’re geographically separated. At this point, it seems she may continue to suffer until she’s reached her limit, then hopefully she’ll look to alternate sources for answers. My heart goes out to each of you and I hope she obtains relief soon, one way or another. :console2:
 
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Worriermum

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Ah right, Primary Care Physicians are known as GPs (General Practitioners) in the UK - and that is who she spoke to. They are rushed off their feet (generally, but particularly now with things as they are) and this was a telephone consultation and the GP wouldn't address any further questions - just discussed the medication. It sounds like she was quite helpful but only up to a point. There is a certain amount of to-ing and fro-ing required here (I am not sure if it is the same in the US): you need to go to the GP to get your medication prescribed, but the GP will tell you your surgeon should be dealing with your questions. I suppose this makes sense, but it is frustrating.

I think I will suggest she writes an email to her surgeon with the unanswered questions, since another three weeks is a long time to wait for those answers.

From the point of view of the exercise, it has now been nearly 5 weeks since her operation and she hasn't done any physio for the last few days, but she did spend the whole day out with a friend yesterday (she was becoming very low being on her own all the time and needed to get out - but with the pandemic, socialising has to be done outside at the moment.) She said she didn't do much walking really, spent most of the time sitting down, but is in even greater pain today - and now it is both hips. Really would have thought by now that doing such small things would be getting easier, not harder. I suggested going back to using the crutches but unfortunately, because both hips hurt, she says this doesn't help her at all and actually causes the hip which has not yet had the operation to be worse.

Many thanks again Layla - I do appreciate the support and realise it is a bit weird a Mother writing on here instead of the person who is actually affected!
 

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This drug is not a pain medication and wouldn't normally be prescribed for post-operative pain. It can take as long as 4 weeks for any positive effects to appear when it is prescribed for depression. Is it possible that your daughter has some clinical depression issues? Or maybe she presented her problems in such a way to her GP that it was assumed she did have this type of problem?

At any rate, if it's pain management for hip pain after joint replacement surgery that she is searching for, this medication is probably not the answer. She might be better off to discuss a regimen of Paracetemol taken on a daily schedule every 6 hours with her GP instead.
 

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